Differential Diagnosis of CNS Lesions in AIDS Patients by FDG-PET

Villringer, Kersten; Jäger, Hans Rolf; Dichgans, Martin; Ziegler, Sybille; Poppinger, Jurgen; Herz, Michael; Kruschke, Coletta; Minoshima, Satoshi; Pfister, H.-W.; Schwaiger, Markus

doi:10.1097/00004728-199507000-00004

Cited by 110 publications

(45 citation statements)

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“…Both qualitative visual inspection of the PET images as well as semiquantitative analysis indicated that FDG-PET was able to accurately differentiate between a lymphoma and a nonmalignant etiology for the CNS lesions. Similar results were found by Villringer et al 82 These authors examined 11 patients with AIDS, 6 with toxoplasmosis, 1 with a tuberculoma, and 4 with a primary CNS lymphoma. The FDG uptake within the lesion was compared with the uptake in a contralateral brain area (SUV).…”

Section: Fdg-pet To Differentiate Opportunistic Infections From Lymphsupporting

confidence: 84%

“…87 A number of studies have reported on FDG-PET brain findings in demented AIDS patients as well as in asymptomatic HIV-infected subjects. [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] In an early imaging study using FDG-PET in 12 patients with dementia, Rottenberg et al 94 found relative subcortical hypermetabolism in 9 patients in the early stage of AIDS-related dementia. Disease progression was characterized by reduced glucose uptake in cortical and subcortical gray matter (Fig 7).…”

Section: Pet Imaging With Fdg In Adcmentioning

confidence: 99%

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FDG-PET Imaging in HIV Infection and Tuberculosis

Sathekge

Maes

Wiele

2013

Seminars in Nuclear Medicine

101

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Section: Fdg-pet To Differentiate Opportunistic Infections From Lymphsupporting

confidence: 84%

Section: Pet Imaging With Fdg In Adcmentioning

confidence: 99%

FDG-PET Imaging in HIV Infection and Tuberculosis

Sathekge

Maes

Wiele

2013

Seminars in Nuclear Medicine

101

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“…Solo el 39% de los pacientes en este estudio tenían confirmación histológica de LPSNC. Otros exámenes diagnósticos como la tomografía de emisión de positrones (PET Scan) usando fluorodeoxiglucosa y spin-echo RM espectrocopía van reportado capacidad variable de diferenciar infecciones como toxoplasmosis o tuberculosis del SNC del LPSNC (29)(30)(31). La presencia del virus del Epstein-Barr detectado en el líquido cefalorraquídeo de casi el 100% de los pacientes con SIDA y LPSNC puede ser otro diagnóstico diferencial posible (14,19,(32)(33)(34)(35).…”

Section: Discusionunclassified

Diagnóstico y tratamiento de pacientes con linfomas primarios del sistema nervioso central (LPSN) y sindrome de inmunodeficiencia adquirida (SIDA).

Raez¹,

Angulo²,

Restrepo³

2013

Rev Med Hered

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SUMMARYThe incidence of Primary Central Nervous System Lymphoma (PCNSL) is increasing rapidly. PCNSL is an important lethal complication in AIDS patients. Objective: Our objective was to study the natural history and prognostic factors for survival in patients with AIDS related PCNSL. Material and methods: This is a retrospective cohort study of 75 patients with the diagnosis of AIDS related PCNSL followed at Jackson Memorial Hospital University of Miami. Results: The median age was 37 years. Males comprised 84% of the patients and 55% of the patients were Hispanic. The most common HIV risk factors were homosexuality and multiple sexual partners. The median CD4 count was 15/~L and the median LDH was 1.5x normal. CT Scans of the brain showed multiple lesions in 44% of the patients. Single-Photon Emission CT Scan (SPECT) Thallium-201 of the brain was performed in 2/3 of patients. The most common histologies were immunoblastic and large cell lymphoma. Cranial radiation was given to 72% of the patients and 55% of them did not completed. The median survival of the group was 1.3 months. Univariate and multivariate analysis showed that longer survival was associated with good performance status (ECOG=1-2 Vs 3-4). The presence of prior opportunistic infections, risk factors for AIDS, CD4 counts, level of LDH, ethnicity, gender, duration of symptoms before diagnosis, and race did not influence survival. Conclusions: PCNSL is a neoplasm with a very poor prognosis and short survival even with CNS radiation therapy. Performance status appears to be the main prognostic factor for survival. No significant differences in presentation or outcome were detected between the Hispanic and non-Hispanic patients. RESUMENLa incidencia del linfoma primario del sistema nervioso central (LPSNC) ha crecido rápidamente. El LPSNC as una complicación letal en pacientes con SIDA. Objetivo: Nuestro objetivo fue estudiar la historia natural, métodos diagnósticos, al tratamiento y los factores pronósticos para la sobrevida de 75 pacientes con LPSNC y SIDA seguidos en el Jackson Memorial Hospital/Universidad de Miami. Resultados: La edad media fue de 37 años. El 84% de los pacientes eran hombres y el 55% hispanos. Factores de riesgo más comunes para SIDA fueron homosexualidad y múltiples compañeros sexuales. La cuenta promedio de CD4 fue de 15/ul y al promedio de LDH fue 1.5 veces al normal. La tomografía computarizada del cerebro mostraba lesiones múltiples en el 44% de los pacientes. Gammagrafia computarizada de emisión de fotones con talio-201 (SPECT) del cerebro se realizó en 2/3 de los pacientes. Las histologías más comunes en las biopsias fueron: linfoma inmunoblástico y linfoma de células grandes. La radiación craneana fue ineficiente en el 50% de los pacientes tratados. La sobrevida promedio del grupo fue de 2.2 meses. Análisis univariado y multivariado mostraron que la mayor sobrevida se asociaba con una buena capacidad funcional (ECOG=1-2 vs 3-4). La presencia previa de infecciones oportunistas, la presencia de factores de riesgo de SID...

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“…Several studies using qualitative and quantitative evaluation of PET however have demonstrated the effective separation of lymphoma with high uptake, from other benign conditions where uptake is lower [36][37][38].…”

Section: Primary Central Nervous System Lymphomamentioning

confidence: 99%

PET/CT scanning with a high HIV/AIDS prevalence

Warwick

Sathekge

2011

Transfusion and Apheresis Science

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a r t i c l e i n f oArticle history: Available online xxxx a b s t r a c t Positron emission tomography (PET) with [F-18]-fluoro-deoxy-glucose (FDG) has a well established and growing role in the management of most lymphomas. The interpretation of FDG PET scans in HIV positive patients is however challenging. This is largely due to scan changes giving a higher likelihood of false positive studies from both the direct effects of HIV and its treatment, and related to secondary HIV-related pathology. There is currently a need for further clinical research to evaluate to contribution of FDG PET in the management of HIV positive patients with lymphoma. In this paper existing studies related to FDG PET scanning in HIV positive patients will be reviewed, and potential pitfalls will be identified. These pitfalls can be avoided to some extent by the interpreter having a good clinical knowledge of the individual patients' condition, and an awareness of known scintigraphic patterns that can occur in these patients. PET remains a sensitive tool for the localisation of pathology, however when the exact nature of lesions has a direct bearing on patient management lesions need to be biopsied where possible. FDG PET can be particularly useful for the characterisation of brain lesions suspected to be related to primary central nervous system lymphoma.

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Differential Diagnosis of CNS Lesions in AIDS Patients by FDG-PET

Cited by 110 publications

References 0 publications

FDG-PET Imaging in HIV Infection and Tuberculosis

FDG-PET Imaging in HIV Infection and Tuberculosis

Diagnóstico y tratamiento de pacientes con linfomas primarios del sistema nervioso central (LPSN) y sindrome de inmunodeficiencia adquirida (SIDA).

PET/CT scanning with a high HIV/AIDS prevalence

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